Qualexa Healthcare provides Healthcare Organizations and Medical Practitioners a host of Administrative, Management and TPA, services and functions necessary to be successful in the ever-changing healthcare environment. We provide high-value, low-cost systems and services through economies of scale and efficient technologies. We understand the complexities, intricacies, and specific requirements which are unique to varying risk-bearing entities, such as a Health System (Hospitals); Physician-Hospital Organizations (PHO); Managed Care Organizations (MCO), including Health Maintenance Organizations (HMO)/Preferred Provider Organizations (PPO)/Point of Service plans (POS); Risk Bearing Organizations (RBO); Independent Physician or Practice Associations (IPA – including California Restricted Knox Keene entities); Integrated Delivery Organizations (IDO); Accountable Care Organizations (ACO); Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), and other integrated medical groups. We can provide our business partners with a single function/service or many functions/services, depending upon their needs.
An Accountable Care Organization, or ACO, is a group of hospitals, independent providers and other healthcare organizations who work together to improve the quality of care for Medicare beneficiaries and curb the rising cost of healthcare. For the Medicare beneficiaries we treat, the Centers for Medicare and Medicaid Services (CMS) will reward us in “shared savings.”
Health & Accountable Care Organization Programs
Unlike our current healthcare system, which reimburses providers on a fee-for-service basis, the value-based payment model rewards hospitals and providers for keeping their patients healthy and costs low.
Qualexa Healthcare provides expert services to all types of physicians and physician-led organizations to form and manage an ACO to institute new operating models that address how care is accessed, delivered and financed. We offer a complete set of strategic and management services, from in-depth analysis of each market opportunity through an ACO’s Managed Services Organization operation.
Boa Vida Healthcare has a particular focus and expertise on rural care facilities with unique challenges with payor mix, demographics, service lines and referral management. Boa Vida mobilizes and aligns all stakeholders – employees, payors, employers and community leaders – developing a viable model for providing quality, compassionate care in a long-term sustainable manner.
The fundamentals of our success are rooted deep in core values that have helped us create a systematic and sustainable business model. We are honored to be a trusted partner who serves, gives back and grows with the communities we serve. We are a uniquely physician-founded and physician-led organization that empowers doctors, clinicians and administrative personnel to improve clinical and financial results throughout the healthcare organization.
Qualexa’s expert services are offered a-la-carte or as customizable packages.
Our services include:
- Provide market analysis and strategic counsel
- Recruit physicians into Independent Practice Associations (IPAs) and physician-led Accountable Care Organizations (ACOs)
- Convene comprehensive, integrated, high-quality, multi-specialty networks
- Advise, collaborate with and provide management services to ACOs
- Deploy innovative financial and operating strategies that enable doctors to control care delivery, share in the savings they generate, increase their income streams and have new investment opportunities – all while being insulated against downside risk.
- Advanced technology selection and adoption
- Alternative Payment Model public and payer contracting, design and implementation
- Financial risk management (stop-loss insurance placement/Managing General Underwriter)
- Sources of funds/Capital financing
- Ongoing operation and management of the ACO’s Managed Services Organization
- Ongoing operation and management of the Health Plan associated with the ACO